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Background: Anterograde transnasal flexible endoscopy of the pharynx, larynx, and proximal trachea without sedation has been established since the 1990s. Retroflexed endoscopic functional analysis has recently been introduced., Objectives: Adding retroflexed functional endoscopy from the oral cavity up to the duodenum to anterograde diagnostics allows the precise demonstration of how different factors interact in a complex way, e. g., in case of dysphagia or pathological reflux., Materials and Methods: A 70-cm-long high-definition endoscope without a channel system is equipped with a 200° retroflexed view, a mm-cm scale, and a roller system. The endoscope can be lengthened, stopped, or shortened during the procedure. Standard positions, viewing directions and display details ensure that findings are comparable. Mastication, food transport and digestion are observed in the unsedated patient., Results: Depending on indication and symptoms, we defined a diagnostic algorithm including three specific pathways: (1) for conditions that originate in the oral cavity, larynx or pharynx, (2) for suspected reflux disease, or for neurological or neuromuscular disorders of food transport, (3) for duodenogastric, gastroesophageal and esophagopharyngeal reflux, as well for benign or malignant tumors., Conclusion: The advantages of functional endoscopy have an impact not only on the medical staff and patients. Its precise and participatory approach is relevant to healthcare, enlarges the diagnostic horizon, and forms a basis for interdisciplinary collaboration.

ENT specialists and gastroenterologists are increasingly confronted with the question of how to recognize and evaluate extra-esophageal complications of reflux. Both specialities need to collaborate, since they are connected via the esophagus, and both need to know more about the speciality of their neighbor than was hitherto usual. This publication presents the observations and measurements of little-known physiological functions. This is followed by an attempt to define the border between healthy and diseased. Finally, the possible consequences of functional disorders are described. The leap from observation of function to the microcosm of biochemical links is discussed and supported using experimental work. This overview highlights the limitations of our current knowledge. The success of functional endoscopy in terms of therapeutic approaches is immense. The required therapy is finally based on a clear diagnostic concept; probatory therapy is a waste of money.

Surgical voice restoration during and after total laryngectomy using Blom-Singer puncture and the glottoplasty techniques provide good results. There is no doubt that the proportion of patients with a good voice is higher after surgical voice restoration than with the use of the esophageal speech or electronic speaking aids. Nevertheless there are problems due to the shunt or the necessary daily changing of the prosthesis with its risks, and failures due to the tracheostomy, the prosthesis and the pharynx. In order to reduce these surgical problems we developed new instruments, a personal surgical procedure for restoration during and after laryngectomy using this set of instruments, a new type of prosthesis and a tracheostoma valve. This technique allows the patient to speak fluently without using his hands, to breathe and to swallow without aspirating.

The Blom-Singer puncture is a new operative technique which can help to make the laryngectomized patient speak again even years after laryngectomy. 34 patients were treated with a modified procedure. 5 patients with a good voice gave up despite intensive medical and speech therapy. Painstaking postoperative treatment is needed to make the Blom-Singer puncture successful. Patients who had a Blom-Singer prosthesis fitted after a neoglottis procedure spoke after only brief instruction without speech therapy being necessary.

Surgical voice restoration is possible years after laryngectomy by using hypopharyngeal puncture and cricopharyngeal myotomy if necessary. We have developed a technique of insertion of the ESKA-Herrmann tracheostoma valve for fingerfree speech. The patient moistens and cleans the tracheostoma valve every day. The quality of fingerfree speech is the best of all known techniques.

A simple operative technique is presented which restores speech without any later risk of aspiration in a one-stage operation performed together with the laryngectomy. 4 types can be distinguished depending on the extent of the resection and the amount of reconstruction necessary. The surgical technique is described. Resection of the tumour is not restricted. Our results on 85 patients are presented. Attention is drawn to mistakes and dangers.

During the last 4 years over 1500 thin-needle aspiration biopsies from tumors in the head and neck region were carried out in the University-ORL-Clinic of Würzburg. 306 cytological results were compared with the histological diagnoses. None of the benign tumors was classified cytologically as malignant (false positive = 0%). 84% of the malignancies were attached to the groups III, IV or V according to the so called Pap.-staging. The rest could not be detected by this method because of technical mistakes as well as accidental false punctions. Some types of tumors could be classified histogenetically in high percentage of cases, especially the pleomorphic adenoma of the glandula parotis and carcinoma metastases.